The effect of dynamic neuromuscular stabilization exercises on balance, proprioception and functional level in patient with lower extremity lymphedema

Introduction: In lower extremity lymphedema, joint position sense and balance are negatively affected. This can lead to injuries, and injuries may cause tissue damage and further increase proprioception deficits, creating a vicious cycle. Purpose: The aim is to investigate the effects of Dynamic Neuromuscular Stabilization (DNS) exercises on balance, proprioception, and functional level in patients with lower extremity lymphedema. Method: Female patients diagnosed with lower limb lymphedema due to primary or secondary causes and who had progressed to Phase 2 of Complex Decongestive Phsysiotherapy (CDP) with Stage 2 lymphedema were randomly assigned to a DNS Group (n=21) and a Control Group (n=21). Both groups participated in an exercise program that included diaphragmatic breathing exercises, active range of motion exercises, and walking. The exercises were given as a home program for 6 weeks, 3 days per week, 45 minutes per day. Additionally, for 6 weeks, the DNS Group performed DNS exercises for 40 minutes, 2 days a week, while the Control Group did an additional 40 minutes of walking during the same time. Participants were evaluated using the circumferential Measurement Method (CMM), Single Leg Stance Test (SLST), Y Balance Test (YBT), Joint Position Sense Test (JPST), 10-Meter Walk Test (10MWT), Lower Extremity Functional Scale (LEFS) and the Fall Efficacy Scale-International (FES-I) before and after the 6-week intervention. Results: In the DNS group, a statistically significant improvement was observed after the intervention in limb volume, static and dynamic balance, proprioception, functional level, and fear of falling. No statistically significant differences were found in the control group following the intervention. Compared to the control group, the DNS group showed statistically significant differences in JPST at the hip, knee, and ankle (p=0.01), SLST with eyes open (p=0.04) and closed (p=0.01), the posteromedial direction of the YBT (p=0.04), 10MWT (p=0.01), and LEFS (p=0.03). Conclusion: DNS exercises may be an effective method for improving proprioception, balance, and functional level in Stage 2 lower extremity lymphedema patients who have progressed to Phase 2 of CDP.